Open enrollment begins Thursday

Help available for those seeking to change Medicare Part D coverage

Help available for those seeking to change Medicare Part D coverage

November 11, 2007

By Marjorie Zastrow Brown County Extension Service Between Thursday and Dec. 31, Medicare recipients will have an opportunity to make changes concerning their prescription drug coverage under Medicare Part D for 2008. The open enrollment period will allow policy holders, as well as those enrolling for the first time, to review policies available to be sure they have the coverage which best fits their needs. Private companies on a yearly basis revise the plans they offer and position themselves in the market and create marketing strategies to entice new clientele. For Medicare Part D recipients, this creates the necessity to evaluate if the plan they are currently enrolled in is the best option for them in 2008. Beneficiaries may find significant differences between the coverage they have in 2007 as compared to 2008, if they stay with the same company in respect to the prescription drugs they cover (the formulary), the terms and cost of the coverage. In 2008, there will be 52 standalone plans, of which 28 offer enhanced benefits (over and above what the Medicare contract requires). Thirty plans of the 52 do not have a deductible and the premiums range from $13.90 to $99. Each Medicare recipient has a unique “prescription profile” (the prescription drugs they take, the dosage and frequency they take the medication), so what plan is appropriate for one person may be significantly different for another person when considering their prescription profile. It is important that individuals check out plans that fit their personal situations. Individuals who enrolled in a Medicare Prescription Drug policy in 2007 should have received, or will be receiving, a notice from their company informing them of their 2008 Policy coverage and rate. If individuals had a policy that does not cover a prescription drug they take, if they met the doughnut hole, if their plan formulary is changing or if there will be a premium increase, they certainly want to explore 2008 coverage and premium options from all companies offering policies. Though participation in a Medicare Part D policy is optional, individuals who do not have credible coverage when they were able to select coverage will face a 1 percent per month penalty added on to their premium. The penalty is based on the National Average Premium. Individuals who have not enrolled and have been eligible for coverage since May 2006 will face a 13 percent ($3.64) penalty added on to their monthly premium if they choose coverage for 2008. If they do not choose coverage during the open enrollment (Nov. 15-Dec. 31), they will not be able to select coverage until open enrollment late next year and will then face a 25 percent premium penalty for coverage beginning in 2009. A low-income subsidy is available for individuals with limited income and resources. Guidelines for assistance are for those with incomes below $15,315 for a single person and $20,535 for a couple. Resource limits (checking, savings, CDs, investments) are $11,710 for a single and $23,410 for a couple. In most instances, individuals/families need to complete an application requesting assistance. Assistance for qualifying individuals is provided in reduced or no premium, and limited co-pay or percent of drug cost paid. Individuals who currently receive low-income subsidies may have received a letter from the Social Security Administration asking if there has been a change in their resources or income. If changes have been made, they may need to reply to the letter sent and subsequent requests. Failure to reply to subsequent requests may result in withdrawal of their low-income subsidy. Individuals or families looking to sort through options have a number of resources to explore. Part D Insurance policies may be sold/marketed through local agents. If individuals purchase a policy from a local agent, they want to know if that agent compared their policy options among all companies or a select number, since policy coverage and premiums vary significantly. Personalized Medicare Part D policy comparisons with all plans available are available at www.Medicare.gov, 1-800-633-4227 (Medicare); 1-800-536-8197 (SHIINE); local Extension Offices, some local insurance agents, and selected program sites. Seniors, their family members or authorized representatives may contact any of the agencies previously listed. SHIINE is short for Senior Health Information and Insurance Education Program. For more information, call the Brown County Extension Service at (605) 626-7120.